Predicting Patient Satisfaction at Hospital Discharge: Lupus Patients & Fatigue

Overview: Lupus patient satisfaction with a hospitalization was significantly higher if fatigue was not one of the reasons a person sought medical care.

The dataset used for this analysis was created using polling of a lupus-specific community, LupusCorner. This strategy of using disease-specific, patient-reported metrics to identify areas where hospitals/clinicians can focus improvement efforts will yield the most positive results for both patients and hospitals.

Making sense of the dots

Call it patient centricity, consumerism in healthcare, patient engagement, or some other buzzword, the takeaway is the same: evaluating & improving patient experiences with their health systems is a now an expectation. Payment mechanisms like Hospital Value-Based Purchasing and MIPS/APMs are incentivizing a shift from paying for services to paying for outcomes.

These regulatory changes have opened the door for a new type of health care analysis. The Agency of Healthcare Research and Quality (AHRQ) initiative CAHPS is one tool designed to provide feedback for value-based payments. While these surveys may be useful as a barometer of patient experience, they do not offer the granularity that can help individual health practices improve — instead stopping in the publicly available data at the health specialty and state level. Actionable insights exist at a more personal level but are currently being missed by providers and data scientists.

The CAHPS 2016 Adult Survey 2.0 found that 54% of patients reported that providers did not pay attention to patient’s mental or emotional health. These patient needs may be harder for patients to verbalize and for clinicians to impact. But, they are clearly detrimental to patient satisfaction.

Karate Health offers a bridge between these types of traditional datasets and the patient voice. This results in unique insights and testable hypotheses for improving care. A survey soliciting feedback on recent hospitalizations highlights the effectiveness of this strategy.

The premise: Are patient-reported reasons for hospitalizations predictors of overall patient satisfaction with the hospital stay?

Survey: The survey was publicly available online through LupusCorner and affiliated social media sites. The survey gathered the following information:

• time since lupus diagnosis
• ethnicity
• number of hospitalizations since July 2016
• duration of hospitalizations
• symptoms experienced when seeking medical care
• satisfaction with most recent hospitalization (1–5 Likert scale)

Findings: In total, 1,052 people completed the survey. The messaging attracted people with recent hospitalizations to participate. 51% of respondents experienced at least 1 hospitalization in the previous 18 months. That is higher than a study that estimated annual lupus hospitalizations to occur for between 8.6% and 18.9% of patients, but this can be attributed to the survey messaging.

While there were additional validation points and findings, here I will focus on the presence of fatigue as a determinant of satisfaction. There were 689 responses of people that both had lupus & provided a patient satisfaction score. 173 people reported fatigue as a reason for hospitalization. See Figure 1 for a breakdown of satisfaction scores based on whether or not fatigue was a presenting symptoms.

Figure 1. Differences in patient satisfaction with hospitalization as a result of fatigue (patient-reported reason for hospital admission). N=689

For analysis, I subdivided patient satisfaction into four groups:

• Medium satisfaction (scores of 3) & reported fatigue (53 responses)
• High satisfaction (scores of 4 or 5) & reported fatigue (83 responses)
• Medium satisfaction (scores of 3) & no reported fatigue (122 responses)
• High satisfaction (scores of 4 or 5) & no reported fatigue (288 responses)

Significant differences were found using a chi-square suggesting that patients with high satisfaction were significantly less likely to have reported fatigue than people with medium satisfaction (chi-square statistic = 3.9815, p<0.046).

Implications: As financial incentives shift in the healthcare ecosystem to more directly value patient feedback, providers and insurance companies will look to improve with this type of granular, problem-focused analysis. A new wave of patient tools is necessary to fill care gaps that may not be high priorities for clinicians.

Clinicians need to offer a product that is valuable to both providers (low cost; returns useful patient-reported data into the practice) and patients (doctor addresses specific concerns; provides outside-of-clinic support; increases satisfaction; trending for improved outcomes).

Karate Health has created Tackle Fatigue to serve this purpose. Combining longterm benefits with immediate increases in patient satisfaction, Tackle Fatigue is the first in a pipeline of low-cost patient tools. The best part for health practices exhausted from EHR installs and optimizations: going live with Tackle Fatigue requires no provider-specific customization. Clinics will see an increase in patient satisfaction simply by providing the appropriate patients with an access code.

Work with us! Today, the data necessary for this level of granular analysis is nearly impossible to come by. Health systems often blind patient satisfaction metrics, curtailing analysis at the specialty or clinic level.

The Karate Health infrastructure relies on patient-reported data (reason-for-visit, satisfaction surveys, orders/medications) to develop first-of-their-kind, longitudinal datasets. Our direct-to-patient strategy also provides for a geographic, national, and even global assessment of health trends.

Looking to conduct research on a dataset that seems impossible to create? Trying to improve patient engagement AND patient satisfaction? Reach out and let’s dig deeper to improve health outcomes.

Email: brett@karatehealth.com — www.karatehealth.com